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Acknowledgement: SA Kraft JD, KE Kruse MD, and B Fishbeyn MS played integral roles in data collection and analysis for the initial empirical work which ultimately inspired this paper.
PL Kunz MD supplied a clinical case that we de-identified and altered to illustrate the main points of this paper.
Introduction
During discussions with patients who are seriously ill and their families, physicians must communicate whether the patient or medical condition is ‘treatable.’ That is, they must explain whether or not there are available therapeutic interventions for the clinical issue at hand. Physicians use a variety of particular words and phrases to communicate that something (a “treatment”) can be done; in this paper, we call this family of statements “treatability statements.” Examples of treatability statements include, but are not limited to:
1) “This is a treatable condition.”
2) “We have treatments for your loved one.”
3) “We have interventions we can offer for this condition.”
4) “We can do something about this.”
In prior qualitative work exploring these statements,1 we demonstrate substantial differences between physicians and patients, and amongst physicians, in how treatability statements are used and interpreted. For simplicity, we use ‘patients’ to refer to any nonphysician involved in a discussion or decision about a patient who is seriously ill, including the patient him- or herself, family members, other surrogate decision makers, etc.
Patients typically understand treatability statements as communicating good news for the patient’s life and future (e.g., “Your condition can be treated” might mean “Your condition is not terminal,” “You will survive,” or “You will not be limited by this disease”).
Physicians typically understand treatability statements through an entirely different lens: as communicating that treatment is available, without necessarily communicating improvement in prognosis or quality of life. Some physicians use treatability statements to communicate that disease-directed treatments are still available for an incurable disease (e.g., “Your cancer is treatable” might mean “Although your cancer is incurable, we can still treat you with palliative chemotherapy”). Other physicians use treatability statements to communicate that treatments may potentially cure or reverse a pathophysiological process (e.g., “We can treat the sepsis” might mean “We can potentially reverse the sepsis and return you to baseline”). To bluntly highlight the discordance, treatability statements can have opposite meanings to...